Osteoporosis

Osteoporosis

  • Calcium and bones
  • Osteoporosis (bone thinning) as seen on a bone scan

Definition

Osteoporosis is the loss of bone density or thinning of the bones. This thinning causes bone weakness, and eventually the involved bone may break.

What is going on in the body?

Bones go through a constant state of bone loss and regrowth. People reach their peak bone mass by about age 30. After the age of 30, bone loss slowly begins to occur. This loss, if it becomes severe, can lead to osteoporosis. The bones become thin and fragile and may break easily.
Initially, bone loss occurs very slowly for both women and men. After the age of 65 to 70, men begin to lose bone more rapidly. Women, on the other hand, begin to lose bone more rapidly after they reach menopause and the body's estrogen level falls. Women may also begin to lose bone more rapidly if they have their ovaries removed during surgery before they reach menopause.
Bone is made up of calcium and proteins. There are two types of bone: compact and spongy. Each bone in the body has both types of bone in different amounts. The first signs of osteoporosis are seen in bones that have a lot of spongy bone. These include the hip, spine, and wrist bones.

Risks

What are the causes and risks of the condition?

Some risk factors for osteoporosis cannot be changed. These include:
  • Age. Bone density decreases with age.
  • Body size. Women with small, thin bodies are at the highest risk.
  • Ethnic background. Caucasian and Asian women are at the highest risk, while Latino and African American women are at somewhat less risk.
  • Family history. Reduced bone mass and risk for bone fractures seem to run in some families.
  • Gender. Women have less dense bones than men and lose more bone mass during and after menopause.
Other risk factors for osteoporosis can be changed, such as:
  • cigarette smoking
  • a diet low in calcium and vitamin D
  • eating disorders, such as anorexia and bulimia
  • excess alcohol intake
  • low hormone levels associated with menopause
  • medicines such as corticosteroids, certain medicines for seizures or high blood pressure
  • sedentary lifestyle
Some of the diseases and conditions that can increase an individual's risk for osteoporosis are as follows:
  • cancers affecting the bone
  • eating disorders, such as anorexia and bulimia
  • hyperparathyroidism, a condition in which the parathyroid gland makes too much parathyroid hormone
  • hyperthyroidism, a condition in which the thyroid gland makes too much thyroid hormone
  • hypogonadism, a condition in which the ovaries in women or testes in men do not function normally
  • rheumatoid arthritis , a condition in which the body attacks its own joint tissue

Prevention

What can be done to prevent the condition?

It is important to think about prevention early, starting in the teenage years and continuing for the rest of life. Teens who exercise a lot will build more bone mass and therefore be less affected by bone loss later in life.

Bone loss can be slowed by 30 minutes of moderate weight-bearing exercise a day. Weight-bearing exercise includes low impact aerobics, walking, running, lifting weights, tennis, and step aerobics. A person exercising at a moderate level can talk normally without shortness of breath and is comfortable with the pace of the activity. The 30 minutes a day can be done in one session or several smaller segments.
Low impact aerobics and water aerobics are examples of exercises that minimize joint stress in elderly individuals or people who have arthritis. Recent research has shown that people who do high impact activities such as jogging have less bone loss as they age. Bone loss can be slowed by eating a well-balanced diet starting again in the teen years, following the food guide pyramid.
It is important to get enough calcium and vitamin D. There is some evidence that a diet high in fat may cause bones to thin more rapidly. Eating soy protein can lower a person's risk for osteoporosis.
Some other options for reducing bone loss include:
  • Avoid smoking.
  • Get effective treatment for conditions such as hypogonadism, rheumatoid arthritis, and hyperthyroidism
  • Limit alcohol intake.
The Food and Drug Administration, or FDA currently approves selected medicines for prevention of osteoporosis. These medicines that slow or stop bone loss, increase bone density, and help prevent bone fractures are as follows:
  • biphosphonates, specifically alendronate (i.e., Fosamax) and risedronate (i.e., Actonel)
  • estrogen or hormone replacement therapy for women
  • selective estrogen receptor modulators, or SERMs, specifically raloxifene (i.e., Evista)

Diagnosed

How is the condition diagnosed?

Osteoporosis may be discovered in an X-ray taken for some other problem. X-rays should not be used as the only test. At this time, the most commonly used and reliable test is the DEXA scan. Other tests include the following:
  • blood bone markers, which measure collagen protein in the bone
  • tests for serum osteocalcin, which is a marker of bone formation
  • tests that measure calcium in the urine, which increases in a person who has osteoporosis

Long Term Effects

What are the long-term effects of the condition?

Untreated osteoporosis can lead to bone fractures that may result in permanent disability. One in five women over the age of 70 and one in three women over the age of 80 will suffer a hip fracture during her lifetime. Nearly one in five women with a hip fracture will die within 6 months of the injury.
Death following a hip fracture is usually the result of complications from immobility, such as pneumonia or pulmonary embolus. One third of women older than 65 years of age will have a fracture of the spine caused by osteoporosis. Chronic back pain resulting from fractures of the spine may prevent some physical activities and affect normal sleeping.

Other Risks

What are the risks to others?

Osteoporosis is not contagious and poses no risk to others.

Treatments

What are the treatments for the condition?

Certain medicines are currently approved by the FDA for treatment of osteoporosis. Some of these medicines may slow or stop bone loss, increase bone density, and help prevent bone fractures. They include the following:
  • biphosphonates, specifically alendronate (i.e., Fosamax) and risedronate (i.e., Actonel)
  • calcitonin
  • estrogen hormone replacement therapy for women
  • selective estrogen receptor modulators, or SERMs, specifically raloxifene (i.e., Evista)
Parathyroid hormone, on the other hand, works by increasing bone mass rather than slowing bone loss. It is given as an injection under the skin each day. The FDA has approved parathyroid hormone for the treatment of osteoporosis and it can be used in men and women who have a high risk of bone fracture. Studies have shown that it helps prevent hip and spine fractures.

Side Effects

What are the side effects of the treatments?

Bisphosphonates can irritate the esophagus and stomach and can cause nausea and heartburn if not taken exactly as prescribed. SERMs can cause leg cramps, hot flashes, and occasional blood clots. HRT can cause bloating, breast tenderness, vaginal bleeding, blood clots, and possibly increase the risk of breast cancer. Calcitonin may cause runny nose, nausea, and flushing. Parathyroid hormone can cause nausea, headache, dizziness, and leg cramps.

After Treatment

What happens after treatment for the condition?

After a person develops osteoporosis, treatment is lifelong. The home should be made safe to prevent injuries. Ways to increase safety include the following:
  • Do not lift heavy objects.
  • Do not use throw rugs on floors.
  • Keep all areas safe, well lit, and uncluttered to prevent falls.
  • Take care with icy, wet, or slippery surfaces.
  • Use a cane if needed.
  • Use nonskid mats in the shower and bathtub.
  • Use proper back support and lifting methods.
  • Wear comfortable shoes that have nonslip soles.
  • Wear undergarments that have a protective pad around the hips to prevent hip fractures.
Intriguing new research done in older individuals with arthritis found that brisk walking or weight training improved balance in those individuals. Improved balance could very well help individuals with osteoporosis avoid hip fractures and wrist fractures from falls.

Monitor

How is the condition monitored?

Women on HRT should have yearly physicals and pelvic examinations, mammograms, and PAP smears. Repeat DEXA bone scans may be performed to see the effect of treatment on bone density. Sometimes urine tests may be done to look at bone markers. Any new or worsening symptoms should be reported to the healthcare professional.

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